Abstract

Non-communicable diseases account for more than 50% of deaths in adults aged 15–59
years in most low income countries. Depression and diabetes carry an enormous public
health burden, making the identification of risk factors for these disorders an important
strategy. While socio-economic inequalities in chronic diseases and their risk factors
have been studied extensively in high-income countries, very few studies have investigated
social inequalities in chronic disease risk factors in low or middle-income countries.
Documenting chronic disease risk factors is important for understanding disease burdens
in poorer countries and for targeting specific populations for the most effective
interventions. The aim of this review is to systematically map the evidence for the
association of socio-economic status with diabetes and depression comorbidity in low
and middle income countries. The objective is to identify whether there is any evidence
on the direction of the relationship: do co-morbidities have an impact on socio-economic
status or vice versa and whether the prevalence of diabetes combined with depression
is associated with socio-economic status factors within the general population. To
date no other study has reviewed the evidence for the extent and nature of this relationship.
By systematically mapping the evidence in the broader sense we can identify the policy
and interventions implications of existing research, highlight the gaps in knowledge
and suggest future research. Only 14 studies were found to analyse the associations
between depression and diabetes comorbidity and socio-economic status. Studies show
some evidence that the occurrence of depression among people with diabetes is associated
with lower socio-economic status. The small evidence base that considers diabetes
and depression in low and middle income countries is out of step with the scale of
the burden of disease.